Chapter 27: Management of Patients with Coronary Vascular Disease

A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? a.) Cholesterol plugs in the lumen of veins b.) Blood clots in the arteries c.) Fatty deposits in the lumen of arteries d.) Emboli in the veins

c.) Fatty deposits in the lumen of arteries

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? a.) Hemoglobin of 16 g/dL b.) Hematocrit of 30% c.) Heart rate of 87 bpm d.) Blood pressure of 129/72 mm Hg

b.) Hematocrit of 30%

A 62-year-old male client who works as a stockbroker reports chest pain and palpitations during and after his morning jogs. The client's family history includes CAD. His lipid profile reveals his LDL level to be 122 mg/dL. The nurse is aware that this client has which of the following? a.) Normal LDL level b.) High LDL level c.) Fasting LDL level d.) Low LDL level

b.) High LDL level

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? a.) Hypertension b.) Hypotension c.) Urinary incontinence d.) Hyperactive bowel sounds

b.) Hypotension

A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? a.) Improve arterial flow b.) Improve venous return c.) Strengthen venous valves d.) Increase venous congestion

b.) Improve venous return

A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: a.) Decreased myoglobin levels b.) Elevated troponin levels c.) Decreased LDH levels d.) Increased C-reactive protein levels

b.) Elevated troponin levels

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a.) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. b.) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. c.) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. d.) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.

a.) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a.) Assess the client's level of pain and administer prescribed analgesics. b.) Ensure that the client's family is kept informed of his status. c.) Prepare the client for pulmonary artery catheterization. d.) Assess the client's level of anxiety and provide emotional support.

a.) Assess the client's level of pain and administer prescribed analgesics.

Which condition most commonly results in coronary artery disease (CAD)? a.) Atherosclerosis b.) Renal failure c.) Diabetes mellitus d.) Myocardial infarction

a.) Atherosclerosis

A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a.) Chest discomfort not relieved by rest or nitroglycerin b.) Cool, clammy, diaphoretic, and pale appearance c.) Intermittent nausea and emesis for 3 days d.) Anxiousness, restlessness, and lightheadedness

a.) Chest discomfort not relieved by rest or nitroglycerin

A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a.) Decreases resting heart rate b.) Increases cardiac output c.) Decreases platelet aggregation d.) Decreases cholesterol level

a.) Decreases resting heart rate

Which of the following is inconsistent as a condition related to metabolic syndrome? a.) Hypotension b.) Dyslipidemia c.) Insulin resistance d.) Abdominal obesity

a.) Hypotension

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? a.) Leads V3 and V4 b.) Leads I, aVL, V5, and V6 c.) Leads II, III, and aVF d.) Leads V1 and V2

a.) Leads V3 and V4

Which of the following is the analgesic of choice for acute MI? a.) Morphine sulfate b.) Motrin c.) Aspirin d.) Demerol

a.) Morphine sulfate

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? a.) Potassium b.) Calcium c.) Magnesium d.) Sodium

a.) Potassium

The nurse is caring for a patient following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which of the following medications to neutralize the unfractionated heparin the patient received? a.) Protamine sulfate b.) Aspirin c.) Alteplase (t-PA) d.) Clopidogrel (Plavix)

a.) Protamine sulfate

Following cardiac surgery, the nurse assesses the patient for indicators of the common complication of hypovolemia. Choose the significant indicator. a.) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg b.) Central venous pressure (CVP) reading of 8 mm Hg c.) Heart rate of 60 bpm d.) Blood pressure reading of 130/95 mm Hg

a.) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg

The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? a.) Vague symptoms b.) Decreased sensation to pain c.) Chest pain is typical d.) Gender bias

a.) Vague symptoms

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a.) Withhold anticoagulant therapy. b.) Inform client of diagnostic tests. c.) Remove hair from skin insertion sites. d.) Assess distal pulses.

a.) Withhold anticoagulant therapy.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a.) anticoagulant. b.) antibiotic. c.) antihypertensive. d.) anticonvulsant.

a.) anticoagulant

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? a.) Blood vessels b.) Heart c.) Bronchi d.) Uterus

b.) Heart

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a.) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol." b.) "Client will verbalize the intention to stop smoking." c.) "Client will verbalize the intention to avoid exercise." d.) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours."

b.) "Client will verbalize the intention to stop smoking."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a.) "The pain resolved after I ate a sandwich." b.) "The pain occurred while I was mowing the lawn." c.) "The pain lasted about 45 minutes." d.) "The pain got worse when I took a deep breath."

b.) "The pain occurred while I was mowing the lawn."

Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a.) 100 seconds or less. b.) 50 seconds or less. c.) 75 seconds or less. d.) 125 seconds or less.

b.) 50 seconds or less.

In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? a.) 9 days b.) 60 minutes c.) 6 to 12 months d.) 30 minutes

b.) 60 minutes

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse? a.) Minimal oozing of blood from the IV site b.) Altered level of consciousness c.) Chest pain: 2 of 10 (1-to-10 pain scale) d.) Presence of reperfusion dysrhythmias

b.) Altered level of consciousness

The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? a.) Avoid fatty foods and exercise. b.) Avoid situations that contribute to ischemic episodes. c.) Take over-the-counter decongestants. d.) Report changes in the usual pattern of chest pain.

b.) Avoid situations that contribute to ischemic episodes.

A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? a.) Hypothermia b.) Cardiac tamponade c.) Elevated central venous pressure d.) Hypertension

b.) Cardiac tamponade

A patient is given a prescription for Lopressor, a beta-blocker, after being examined by his health care provider. Select the most important information the nurse should provide. a.) Dress warmly. Blood circulation may be reduced in the extremities. b.) Don't suddenly stop taking the medication without calling your health care provider. c.) If dizziness occurs, adjust the medication. d.) Take the medication at the same time each day.

b.) Don't suddenly stop taking the medication without calling your health care provider.

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? a.) Absent Q wave b.) Elevated ST segment c.) Prolonged PR interval d.) Widened QRS complex

b.) Elevated ST segment

The nurse is caring for a patient newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the patient to address modifiable risk factors for CAD, the nurse will include which of the following? Select all that apply. a.) Alcohol use b.) Elevated blood pressure c.) Drug use d.) Decreased LDL level e.) Obesity

b.) Elevated blood pressure e.) Obesity

A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? a.) Gastrointestinal distress b.) Increased liver enzymes c.) Hyperglycemia d.) Hyperuricemia

b.) Increased liver enzymes

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a.) Hypothermia b.) Pericardial friction rub c.) Decreased erythrocyte sedimentation rate (ESR) d.) Decreased white blood cell (WBC) count

b.) Pericardial friction rub

The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. a.) Bilateral rales and rhonchi b.) Potassium level of 6 mEq/L c.) Serum glucose of 124 mg/dL d.) Weight gain of 6 ounces

b.) Potassium level of 6 mEq/L

A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms: a.) Predictable and consistent pain that occurs on exertion and is relieved by rest b.) Severe, incapacitating chest pain c.) Pain that may occur at rest, but the threshold for pain is lower than expected d.) Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina

b.) Severe, incapacitating chest pain

During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk? a.) Exercise avoidance b.) Smoking cessation c.) Antioxidant supplements d.) Protein-rich diet

b.) Smoking cessation

The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. The nurse includes which of the following information about managing this condition? Choose all that apply. a.) Follow a diet high in saturated fats. b.) Stop smoking. c.) Carry nitroglycerin at all times. d.) Avoid all physical activity. e.) Balance rest with activity.

b.) Stop smoking. c.) Carry nitroglycerin at all times. e.) Balance rest with activity.

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? a.) The patient has compromised left ventricular function. b.) The patient has at least a 70% occlusion of a major coronary artery. c.) The patient has an ejection fraction of 65%. d.) The patient has had angina longer than 3 years.

b.) The patient has at least a 70% occlusion of a major coronary artery.

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. a.) Race b.) Tobacco use c.) Hyperlipidemia d.) Obesity e.) Gender

b.) Tobacco use c.) Hyperlipidemia d.) Obesity

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a.) Intractable b.) Unstable c.) Variant d.) Refractory

b.) Unstable

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: a.) skeletal muscle damage due to a recent fall. b.) myocardial necrosis. c.) cerebral bleeding. d.) I.M. injection.

b.) myocardial necrosis.

A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously? a.) Dizziness b.) Memory lapses c.) Depression d.) Ankle edema

c.) Depression

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? a.) "A burning sensation after administration indicates that the nitroglycerin tablets are potent." b.) "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." c.) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." d.) "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses."

c.) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect? a.) "My vision is blurred, so my blood pressure must be up." b.) "I feel a tingling sensation around my mouth." c.) "My chest pain is decreasing." d.) "I have a bad headache."

c.) "My chest pain is decreasing."

After percutaneous transluminal coronary angioplasty (PTCA), the nurse suspects that a patient, who is on bed rest, may be experiencing the complication of bleeding. The nurse's initial action should be to do which of the following? a.) Decrease anticoagulant or antiplatelet therapy. b.) Notify the health care provider. c.) Apply manual pressure at the site of the insertion of the sheath. d.) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit.

c.) Apply manual pressure at the site of the insertion of the sheath.

You are caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? a.) Assess for any kind of drug abuse. b.) Assess the client's mental and emotional status. c.) Assess the characteristics of chest pain. d.) Assess the skin of the client.

c.) Assess the characteristics of chest pain.

You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a.) Raynaud's disease b.) Arteriosclerosis c.) Atherosclerosis d.) Coronary thrombosis

c.) Atherosclerosis

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? a.) Protamine sulfate b.) Digoxin c.) Atropine d.) Sodium nitroprusside

c.) Atropine

The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following? a.) Measure the blood pressure for hypertension. b.) Check the radial pulse for arrhythmias. c.) Count the respiratory rate for bradypnea. d.) Measure urinary output for dehydration.

c.) Count the respiratory rate for bradypnea.

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a.) A ratio of LDL to HDL, 4.5 to 1.0 b.) Cholesterol, 280 mg/dL c.) High-density lipoprotein (HDL), 80 mg/dL d.) Low density lipoprotein (LDL), 160 mg/dL

c.) High-density lipoprotein (HDL), 80 mg/dL

A patient diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapies. Which of the following statements reflect a goal of rehabilitation for the patient with an MI? a.) Limitation of the effects and progression of atherosclerosis b.) Ability to return the patient to work and a preillness functional capacity c.) Improvement the quality of life d.) Prevention of another cardiac event

c.) Improvement the quality of life

Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a.) Adequate vital capacity. b.) Acceptable arterial blood gas (ABG) values. c.) Inability to speak. d.) Adequate cough and gag reflex.

c.) Inability to speak.

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects: a.) Anuria b.) Overhydration c.) Inadequate fluid volume d.) Normal glomerular filtration

c.) Inadequate fluid volume

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? a.) Restrict alcohol intake to two drinks per day. b.) Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. c.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. d.) Store the drug in a cool, well-lit place.

c.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug.

A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a.) Decreased heart rate b.) High blood pressure c.) Low blood pressure d.) Elevated hematocrit

c.) Low blood pressure

The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? a.) Sinus tachycardia b.) Frequent premature atrial contractions (PACs) c.) ST elevations d.) Isolated premature ventricular contractions (PVCs)

c.) ST elevations

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? a.) To decrease homocysteine levels b.) To dilate coronary arteries c.) To decrease workload of the heart d.) To prevent angiotensin II conversion

c.) To decrease workload of the heart

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a.) Within 5 to 7 days b.) Within 24 to 48 hours c.) Within 6 hours d.) Within 12 hours

c.) Within 6 hours

The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: a.) administer sublingual nitroglycerin. b.) educate the client about his symptoms. c.) enhance myocardial oxygenation. d.) decrease anxiety.

c.) enhance myocardial oxygenation.

A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: a.) lactate dehydrogenase. b.) myoglobin. c.) troponin. d.) creatine kinase.

c.) troponin.

The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse? a.) "Arteriosclerosis is when the vessels become dilated and weakened,whereas atherosclerosis is the deposit of fatty substances in the vessel lining." b.) "Atherosclerosis and arteriosclerosis are disorders in which the lining of the vessels become narrowed due to plaque formation." c.) "Arteriosclerosis and atherosclerosis are the same disorder. The terms are interchangeable." d.) "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis."

d.) "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis."

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? a.) 210-240 mg/dL b.) 280-300 mg/dL c.) 250-275 mg/dL d.) 160-190 mg/dL

d.) 160-190 mg/dL

Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a.) Anxiety b) .Risk for imbalanced body temperature c.) Decreased cardiac output d.) Acute pain

d.) Acute pain

A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease? a.) Assess the physical history of the patient b.) Not important to assess the patient or to notify the physician c.) Assess the blood pressure and administer aspirin d.) Assess chest pain and administer prescribed drugs and oxygen

d.) Assess chest pain and administer prescribed drugs and oxygen

A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? a.) Temperature of 100.2° F (37.9° C) b.) Respiration 26 breaths/minute c.) Pulse rate of 84 beats/minute d.) Blood pressure 84/52 mm Hg

d.) Blood pressure 84/52 mm Hg

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a.) Pain score: 5/10. b.) Heart rate: 66 bpm c.) Blood pressure: 110/68 mmHg d.) CVP reading: 1 mmHg

d.) CVP reading: 1 mmHg

A 56-year-old male client with CAD kept his appointment to see a cardiologist for posthospitalization follow up. The client indicates that he thinks the diltiazem (Cardizem) has been making him nauseous. The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug? a.) Nitrates b.) Diuretics c.) Beta-adrenergic blockers d.) Calcium-channel blockers

d.) Calcium-channel blockers

A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? a.) Raynaud's disease b.) Venous occlusive disease c.) Cardiogenic shock d.) Coronary artery disease

d.) Coronary artery disease

An 80-year-old male client who has been informed by his physician that he has arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is a: a.) Vascular occlusive disease b.) High level of blood fat c.) Condition in which the lumen of arteries fill with plaque d.) Expected part of the aging process

d.) Expected part of the aging process

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a.) Statin b.) Aspirin c.) Angiotensin-converting enzyme (ACE) inhibitor d.) Morphine IV

d.) Morphine IV

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a.) Ativan 1 mg orally b.) Serum electrolytes c.) Chest x-ray d.) Nitroglycerin SL

d.) Nitroglycerin SL

The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a.) IV heparin b.) Thrombolytics c.) IV nitroglycerin d.) Percutaneous coronary intervention (PCI)

d.) Percutaneous coronary intervention (PCI)

A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation? a.) Hourly IV infusion b.) Vascular sites for bleeding c.) Urine output d.) Prothrombin time (PT) or international normalized ratio (INR)

d.) Prothrombin time (PT) or international normalized ratio (INR)

A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography. The nurse understands that the primary advantage of this radiologic test is which of the following? a.) Clear images b.) Less exposure to radiation c.) Less invasive procedure d.) Quantifies calcified plaque

d.) Quantifies calcified plaque

The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is: a.) Described as crushing and substernal b.) Accompanied by diaphoresis and dyspnea c.) Associated with nausea and vomiting d.) Relieved by rest and nitroglycerin

d.) Relieved by rest and nitroglycerin

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a.) Myoglobin b.) CK-MB c.) Total CK d.) Troponin

d.) Troponin

The nurse is reevaluating a patient 2 hours following a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which of the following assessment findings may indicate the patient is experiencing a complication of the procedure? a.) Potassium level of 4.0 mE/qL b.) Heart rate of 100 bpm c.) Dried blood at the puncture site d.) Urine output of 40 mL

d.) Urine output of 40 mL

A patient, who is resting quietly in a step-down cardiac care unit, reports chest pain. The cardiac monitor indicates the presence of reversible ST-segment elevation. The nurse understands that the patient may be experiencing coronary artery vasospasm. This is a type of angina known as: a.) Intractable b.) Silent c.) Stable d.) Variant

d.) Variant

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a.) Thrombocytopenia b.) Formation of blood clots c.) Internal bleeding d.) Worsening angina

d.) Worsening angina

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of: a.) penicillin V or erythromycin (E-Mycin). b.) pentoxifylline (Trental) or acetaminophen (Tylenol). c.) aspirin or acetaminophen (Tylenol). d.) aspirin or clopidogrel (Plavix).

d.) aspirin or clopidogrel (Plavix).

A client is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina can result from: a.) an unpredictable amount of activity. b.) activities that increase myocardial oxygen demand. c.) the same type of activity that caused previous angina episodes. d.) coronary artery spasm.

d.) coronary artery spasm.